Subcommittee on Neurological Disease Committee on Nov. 30th, 2010

[Dr. Rémi Quirion]

Yes, football players and those in other types of sports have a lot of head injuries, and we know that head injuries are a factor in the development of Alzheimer's-type dementia. So the head injury part is not a good thing for boxers or for football players and so on.

When we talk about physical activity or red wine, it also always depends on your background, your genetic background, how you're made, and also the lifestyle you have. This is on average. Basically we are studying 500 people, and we say, on average, higher education or more physical exercise is better for you. But that does not mean that university professors like me will not get Alzheimer's or that the Prime Minister of Canada will not get Alzheimer's. It's an average that we are talking about.

There's another thing that is probably important for members to know. Alzheimer's disease in the end will probably turn out to be a bit of a spectrum of disorder, a bit like cancer. There will be subtypes of the disease.

Maybe a better example would be hypertension. If you have high blood pressure, for some of us the treatment is to dilate the vessel--a vasodilator--for others it's the kidneys, and for others it's the heart. So probably with Alzheimer's disease, in a few years' time when we have better drugs, a group of patients will get one type of drug because it's one protein in the brain, the amyloid protein, that's key. For others, it may be another type of drug.

At the moment, we don't understand enough of the disease process to start to disentangle all that into subgroups. So that's also important to remember.

[Patrick Brown, Conservative, Barrie, ON]

A few weeks ago we heard from a constituent of mine from Barrie, Greg McGinnis. He told us that the current drug plan didn't cover his basic needs in terms of Parkinson's.

Do you have any comments, Mark? You're so involved with the pharmaceutical industry in Canada. What does your research suggest? Are there lots of people with Alzheimer's who have that same challenge, where their drug plans in Canada don't cover basic requirements?

[Mark Ferdinand]

We only have a few drugs that treat Alzheimer's that have been approved for use within Canada within the last six or seven years. We generally see this all across mental health drugs, including drugs for Alzheimer's. So we don't have, let's say, a basket of ten to look at. We're looking at maybe one or two. But when we look at those one or two drugs to treat Alzheimer's, unfortunately, what we see is that most other countries in the OECD--the other 28 countries--provide some form of public coverage for those drugs.

[Patrick Brown, Conservative, Barrie, ON]

What types of drugs are those?

[Mark Ferdinand]

I'll provide you with a list of the drugs. Some of the lists are extensive. The challenge is that in Canada, across the country, we basically do not see a form of public coverage for those same drugs. What we tend to see is that the drugs will have been reviewed by the common drug review and then, generally speaking, across most public plans, not reimbursed.

I mentioned 28% as being the average coverage that we see for these types of drugs here in Canada, whereas we're seeing in excess of 80% to 90% coverage in the other OECD countries for the drugs that will have been approved for use here.

So we're not seeing the same level of sophistication, maybe, in providing access to drugs in Canada's public plans as we see elsewhere in the OECD.

[The Chair, Conservative, Joy Smith]

Thank you so much.

We'll now go to our second round of five minutes. I've been very liberal with the timing, as you've probably guessed by now.

We'll go with Dr. Duncan.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thanks, Madam Chair.

I'm wondering if you're able to provide specific examples of how access to treatment varies through Canada.

Yes, Dr. Gauthier.

[Dr. Serge Gauthier]

That's quite easy, because for Alzheimer's disease right now, there are only two kinds of medicine. One kind, which we've had for 10 years, increases the brain levels of a transmitter called acetylcholine. It was approved in Quebec and Ontario within a year or two, but there was a lag time for the Maritimes by about five years and a lag time for B.C. by about seven years. Now it's across the country.

The second class of drug comes from Germany and Austria, and this medicine is reimbursed only in Quebec, despite evidence building up that not only does this single drug work on another brain transmitter but also the combination of the two classes of drugs, as we have for diabetes and hypertension and most diseases, has an additive benefit to patients.

So we're at a standstill, because the CDR, the central review process, which currently excludes Quebec, seems to have a tendency to refuse all novel compounds. For the specific needs of Alzheimer's patients, there is one compound that has been used in Europe for over 20 years, available in Canada for four years, but reimbursed only in one province.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

I have the privilege of serving the veterans community in Canada. I'm really concerned about PTSD and its possible links with dementia, and mild or more severe traumatic brain injury and its links with dementia, particularly because about one in five may develop PTSD.

I'm wondering if you can talk to those two issues, please.

[The Chair, Conservative, Joy Smith]

Who would like to speak to that?

Dr. Song.

[Dr. Weihong Song]

I can talk a little bit about the basic research side of that link.

Just as my colleague mentioned, in my lab we have had repetitive mild head injuries in the animal model, and it has definitely showed that there is a link between mild head injury and memory deficit, which means dementia.

That actually is a major research field, funded particularly in the States. We cannot access that from the department, but it is budgeted for there. In Canada, Alzheimer's, as a whole, is underfunded, and obviously this is the aspect of the research initiative that needs to be supported and funded.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Is there anyone else?

[Dr. Serge Gauthier]

I can add something on the clinical side, if I may.

There's been some pioneering work done by one of our McGill psychiatrists showing that some beta blockers, used at strategic times after PTSD is manifested, will suppress some of the long-lasting effects. So there is a start to pharmacological manipulation using old drugs to perhaps modify the longer-term impact. That would be under an operating grant in the single-applicant category of funding. But it could also be, perhaps for the veterans, a targeted program for the prevention of cognitive decline in Canadians who served overseas and have PTSD.

[Dr. Rémi Quirion]

Maybe just to add a little bit, this group at McGill, in partnership with a group at Harvard, has a large grant from the U.S. army to try to test this drug, this beta blocker, in the treatment of PTSD. Hopefully we'll have a response on a fairly large cohort of subjects very soon. That's coming.

In terms of head injuries, there's basic research and clinical research that has demonstrated strongly the link between head injuries and the incidence of Alzheimer's disease.

[Kirsty Duncan, Liberal, Etobicoke North, ON]

Thank you.

Worldwide there is concern regarding the human and economic costs of Alzheimer's disease. Many countries have a targeted Alzheimer's strategy. I'm wondering if we need a pan-Canadian dementia strategy. If so, should this be integrated into a larger pan-Canadian neurological strategy?

[Inez Jabalpurwala]

My perspective, and again, this is based on 10 years of really talking to everybody involved from the patient side and the research funding side and the side involving the VHOs, has been that we do need to start thinking about a national strategy that has to do with the whole brain, because of the commonalities. Some of the questions that have been raised have been linking concussion or brain trauma to Alzheimer's. And there are other types of diseases. One of our science leaders is involved in cancer research at SickKids in neuroscience. His lab is now doing Alzheimer's research, because they're discovering that certain cells and how they age is linked to eventually what happens with Alzheimer's cells.

There's so much crosscutting that I think we'll lose a lot of the potential we have in this field if we don't start to bring all these pieces together and understand how all of them fit together in an overall strategy. This does not take away from the fact that patient experiences for these various conditions may be different. That's why I think that the work the voluntary organizations are doing is really important.

But we've all come together on the basis of the science case, because we've all understood as voluntary organizations that there is a common thread that links us together. Maybe if we start working together and consolidating our efforts we can do even more in this field. Rémi mentioned CIHR; they've certainly been a leader in stimulating this type of mindset of collaboration and bringing community together.

[The Chair, Conservative, Joy Smith]

Thank you, Ms. Jabalpurwala. That's the key, isn't it: collaboration.

We'll now go to Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

Thank you, Madam Chair.

One question I asked the previous panels I'll ask again today. When we look at the research funding, one thing we've heard again and again is that an incredible amount of time is spent filling out applications. We've heard some people say that as much as 70% to 80% of the time is spent simply preparing applications for research grants. We've also heard that many very good projects get left off the table.

I'd be curious to hear your perspective on how much time, when it comes to studying Alzheimer's, you believe is put into the actual application process. And what type of research is being left off the table that might be very valuable in Canada?

[Dr. Weihong Song]

For me, as a Chinese Canadian, English is obviously not my native language. I spend probably two or three times more than my colleagues do writing applications. It takes a lot of time. If I want to write a single $120,000-per-year grant, it takes me probably at least three weeks to prepare the whole grant application, which is really a lot of time.

Grants are so important to my lab, particularly the operating grants. The reason is that they allow us to hire graduate students, post-doctoral students, which has a major impact on training the future generation of scientists. It takes lots of time to do it.

[Patrick Brown, Conservative, Barrie, ON]

But three weeks for a one-year grant is a lot less time than what we've heard before.

[Dr. Weihong Song]

One grant is not enough, actually. We have to apply for multiple grants from different agencies. It takes a lot of time to write them and prepare them. Actually, you need a lot of the preliminary data, and we spend a lot of time preparing it.

[Dr. Rémi Quirion]

Most scientists who will be successful, people we have referred to here, will have at least three to four grants from CIHR, and then grants from the Alzheimer's Society of Canada. Often they will have some grants from the United States. To be able to properly run a lab in Canada, to be internationally competitive, you need maybe five of these grants, and all will have deadlines that are different during the year. So you spend a lot of time writing grant applications.

The success rate at CIHR at the moment in grant competitions is between 15% and 20%. Every time you submit, there is a likelihood that you will not get the grant, and the likelihood is much greater. That's challenging, and the success rate has been going down a bit over the years.

In the United States, it's even worse. There it's only 4% at the National Institute on Aging. A lot of scientists are spending a lot of time on that, so we need to change--

[Patrick Brown, Conservative, Barrie, ON]

I have one quick question on that before--

[The Chair, Conservative, Joy Smith]

I think Ms. Jabalpurwala wants to answer.

[Patrick Brown, Conservative, Barrie, ON]

I have one quick question for Rémi before we get to that.

So $30 million is what CIHR funded last year. Are you saying that there were about $150 million in applications?